MACEP Position Statement on Writing Orders

MACEP Position Statement on Writing Orders

The Massachusetts College of Emergency Physicians believes:

Since ambiguity regarding responsibility for patient care is detrimental to quality patient care, Hospital and Emergency Department policies should clearly delineate responsibility for writing holding or admitting orders. These policies should be principally determined by what is in the best interest of patient care, not physician convenience.

Since the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) LD.3.20 standard requires that “Patients with comparable needs receive the same standard of care, treatment and services throughout the hospital”, admitted patients should be cared for by those physicians who have clinical expertise in the care of the hospitalized patient. Since emergency physicians do not routinely provide initial or ongoing in-patient care to admitted patients and are not expected to possess the clinical expertise of multi-specialties such as pediatricians, obstetricians, surgeons, internists, etc, it is in the best interest of quality patient care that the patient requiring admission to the hospital be seen in a timely manner by the responsible admitting physician.

Once the staff physician has accepted the admitted patient, that physician has assumed responsibility for that patient. If a recently admitted patient’s condition changes and a physician response is required, the admitting physician must be knowledgeable enough about that patient’s condition and orders to appropriately respond, in person if necessary. Since the emergency physician’s principle responsibility is to promptly evaluate and stabilize emergent patients arriving to the emergency department, that physician cannot be expected to be available elsewhere in the hospital to assume the responsibilities of the admitting physician.

Since in Massachusetts many emergency departments and their staffs are already routinely operating above capacity, as evidenced by the common practices of diversion and boarding of patients, additionally burdening the emergency physician with non-emergency department patient responsibility compromises the care of both the admitted patient as well as current and near future emergency patients and furthermore would potentially be contrary to JCAHO standard LD.3.15. That rationale requires the “Designation of a physician to manage the care for the admitted patient in a temporary location, without compromising the quality of care given to other emergency department patients”.

Therefore:
The Emergency Physician should not be expected to write any orders (including but not limited to: Holding / Admitting / Boarding) that extend, or appear to extend, control and responsibility for the patient in the in-patient setting beyond treatment rendered in the Emergency Department.